If you are having an emergency, please do not complete this form. Instead, call 911 or the Zepf Crisis Care line at 419-904-CARE (2273), or go to your nearest emergency department immediately.
We are currently accepting new clients ages 12 and older to begin services in September. After submitting this survey, please schedule a phone screening with our clinic assistant. Her scheduling calendar is available on the last page of this survey.
Survey responses are reviewed during regular business hours. After submitting the survey, you will receive a call from the clinic at (419) 530-7280 for a brief phone screening. During the call, the clinic assistant will ask a few follow-up questions, and the screening is expected to take approximately 15–30 minutes.
Our clinic requires clients to pay for their services and does not accept any form of insurance. We use a sliding scale to determine fees, which range from $10–50 for a therapy session ($15–60 for a therapy intake) and $200–650 for an integrated assessment (e.g., for ADHD). About the clinic: UTPC is a training clinic for doctoral students in the UToledo Clinical Psychology program. The therapist assigned to you will be a doctoral student clinician working under the supervision of a licensed faculty psychologist.
After the phone screen, you will be placed on our waiting list, and you will be contacted by your assigned therapist once a spot is available. Various factors influence how quickly the waitlist moves (e.g., if clients terminate, if therapists have bandwidth), so we cannot provide an exact estimate for when you can start therapy at our clinic. 
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